COVID-19 after two years: trajectories of different components of mental health in the Spanish population

Abstract

Aims: Our study aimed to (1) identify trajectories on different mental health components during a two-year follow-up of the COVID-19 pandemic and contextualise them according to pandemic periods; (2) investigate the associations between mental health trajectories and several exposures, and determine whether there were differences among the different mental health outcomes regarding these associations.

Methods: We included 5535 healthy individuals, aged 40-65 years old, from the Barcelona Brain Health Initiative (BBHI). Growth mixture models (GMM) were fitted to classify individuals into different trajectories for three mental health-related outcomes (psychological distress, personal growth and loneliness). Moreover, we fitted a multinomial regression model for each outcome considering class membership as the independent variable to assess the association with the predictors.

Results: For the outcomes studied we identified three latent trajectories, differentiating two major trends, a large proportion of participants was classified into 'resilient' trajectories, and a smaller proportion into 'chronic-worsening' trajectories. For the former, we observed a lower susceptibility to the changes, whereas, for the latter, we noticed greater heterogeneity and susceptibility to different periods of the pandemic. From the multinomial regression models, we found global and cognitive health, and coping strategies as common protective factors among the studied mental health components. Nevertheless, some differences were found regarding the risk factors. Living alone was only significant for those classified into 'chronic' trajectories of loneliness, but not for the other outcomes. Similarly, secondary or higher education was only a risk factor for the 'worsening' trajectory of personal growth. Finally, smoking and sleeping problems were risk factors which were associated with the 'chronic' trajectory of psychological distress.

Conclusions: Our results support heterogeneity in reactions to the pandemic and the need to study different mental health-related components over a longer follow-up period, as each one evolves differently depending on the pandemic period. In addition, the understanding of modifiable protective and risk factors associated with these trajectories would allow the characterisation of these segments of the population to create targeted interventions.

Keywords: COVID-19; growth mixture models; mental health; trajectories.

Figure 1.

Timing of data acquisition and periods relative to the development of the COVID-19 pandemic in Spain. Note: Timeline showing the periods covered by the present study, according to the epidemic periods in Spain, as defined by the national epidemiological surveillance network of the Carlos III National Health Institute. Questionnaires launching is presented with orange dots, whereas blue dots represent relevant highlights of the pandemic.

Figure 2.

Latent trajectories of different components of mental health. Note: The different trajectories were termed as follow: psychological distress (1: ‘chronic’ (n = 518), 2: ‘resilient’ (n = 1,940), and 3: ‘moderately resilient’ (n = 3,072)), personal growth (1: ‘worsening’ (n = 423), 2: ‘progressively ascending’ (n = 3,116), and 3: ‘resilient’ (n = 1,996)), and loneliness (1: ‘resilient – no loneliness’ (n = 2,770), 2: ‘chronic – high loneliness’ (n = 468), and 3: ‘chronic – medium loneliness’ (n = 828)). *Trajectories used as the reference category when multinomial regression models were performed. Blue dots indicate significant changes along the trajectories according to relevant highlights of the pandemic. In particular, we found significant changes in the following periods: period 1 (Spanish Government declared state of emergency), period 2 (beginning of the de-escalation plan), period 3 (Spanish Government declared a new state of emergency), period 4 (notification of a new variant of SARSCoV-2 (VOC B.1.1.7 – Alpha), and started COVID-19 vaccination in Spain), and period 5 (end of the second state of emergency).